The relationship of meta-cognitive skills, working memory, theory of mind and psychological resilience with treatment in children and adolescents diagnosed with attention deficit/hyperactivity disorder

Aims: Medication interruption is an approach that can still be applied in the management of symptoms in patients with attention deficit hyperactivity disorder (ADHD) but has limited evidence-based basis. The aim of our study was to evaluate metacognitive skills, working memory, theories of mind, coping skills with stress and psychological resilience of attention deficit and hyperactivity disorder (ADHD) patients who were followed up in our clinic between November 2023 and December 2024 with a diagnosis of attention deficit and hyperactivity disorder (ADHD) and who were started on medication before and after treatment and after medication holiday in patients who interrupted their medication. As a secondary objective, eating behavior was evaluated before and after treatment in adolescent attention deficit hyperactivity disorder (ADHD) patients aged 12 years and older. Methods: Participants were administered a sociodemographic form before treatment, at least 8 weeks after treatment and at least 2 weeks after treatment in those who discontinued their medication, Affective Disorders and Schizophrenia Interview Schedule for School Age Children (K-SADS-PL), Clinical Global Monitoring Scale (CGI), Metacognition Scale - Child and Adolescent Form (UBS-CE), Nonverbal Cues Detection Skills Test (NCCS), The Faux-Pass Test - Child Form (GTT-C), Numerical Sequence Learning Test (SDLT), Child and Adolescent Psychological Resilience Scale (ÇGPSÖ-12), Dutch Eating Behavior Questionnaire (HYDA), Stress Coping Scale for Children and Adolescents (ÇESBÖ) and DSM-IV Based Screening and Assessment Scale for Conduct Disorders in Children and Adolescents (ÇEDBTDÖ) were administered. Wilcoxon signed-rank and Friedman non-parametric analysis of variance were used in the analyses and p was taken as 0.05 (two-way). Results: The study included 56 patients (76.8% male) with ADHD (75.0% Compound, 25.0% Attention deficit predominant) aged 11.0 ± 2.6 years. Thirty-two patients could be evaluated after treatment and 12 patients after drug withdrawal. It was observed that post-treatment symptom severity of ASD decreased significantly compared to pretreatment and symptom severity after medication holiday was similar to post-treatment severity. Parental reports supported that hyperactivity/impulsivity symptoms were significantly lower and similar after treatment and after medication holiday compared to pretreatment. Post-treatment GTT-C correct responses increased significantly and were similar to those after the drug holiday. In other tests, performance before, after and after the drug holiday did not show a significant difference. Conclusion: Our findings suggest that medication reduces the severity of clinician-assessed ADHD symptoms and parent-assessed hyperactivity/impulsivity symptoms, may improve ToM performance, and that this effect may persist after a two-week medication break. The effects of longer medication breaks in children with ADHD should be evaluated in additional studies. Keywords: working memory, attention deficit hyperactivity disorder, metacognitive skills, psychological resilience, stress coping skills, eating behavior, theory of mind